According to data from the Boston Globe, Massachusetts health insurance companies pay a handful of hospitals far more for the same work even when there is no evidence that the higher-priced care produces healthier patients. In fact, sometimes the opposite is true: Massachusetts General Hospital, for example, earns 15% more than Beth Israel Deaconess Medical Center for treating heart-failure patients even though government figures show that Beth Israel has for years reported lower patient death rates, the investigation found.
It's the annual open enrollment season in corporate America, when employees choose their medical plans for the coming year. But this time, many workers are finding that the buffet of options has been trimmed to a very short menu. And typically the offerings now include a health plan with a high annual deductible that is likely to be $1,100 or more for an individual, and much higher for family coverage.
South Korea has joined Thailand, Singapore, India, and other Asian nations in the lucrative business of medical tourism. The number of foreigners coming to South Korea for medical care is still a fraction of those getting treatment in India, Thailand, and Singapore, industry officials said. But clinics and the South Korean government are trying hard to attract these tourists, who not only bring in money for cash-strapped hospitals but also help the economy by staying after their procedure is over. The South Korean government has revised immigration rules to allow foreign patients and their families to get long-term medical visas and altered laws to permit local hospitals to form joint ventures with foreign hospitals in some cases.
For generations, Los Angeles County-USC has been seen as the hospital of last resort. But as the crowded hospital moves into its new, smaller home, officials have a message to its most frequent users: Please, please stop coming in so much. Because the hospital serves the poor and uninsured, some patients come back time and again, contributing to overcrowding. So about four years ago a Los Angeles-based nonprofit was asked to study why some patients visit the emergency room so frequently.
Gov. M. Jodi Rell has reversed a contentious plan that required doctors and hospitals wanting to participate in Connecticut's insurance program for children to join her new program for uninsured adults. Rell acknowledged that the network of healthcare providers has not yet grown large enough to handle all the patients. That has been a sticking point for many Democrats in the General Assembly, activists for the poor and uninsured, and most of the state's congressional delegation. They worry that linking the state's two insurance programs would risk healthcare services to needy children.
Brooksville, FL-based Crescent Clinic is a no-pay primary care medical facility staffed by volunteers, mainly Muslim doctors who want to pay back the community that has nurtured their careers. Since its opening in the summer, the clinic has been seen close to 1,000 patients, including some 50 on a recent Saturday, said medical chief of staff Husan Abuzarad. The doctors now hope to expand hours to help meet the high demand.
Arguing that "doing nothing is not an option," Louisiana Gov. Bobby Jindal has proposed restructuring Louisiana's healthcare program for the poor into a private insurance model that relies on managed-care principles to control costs and improve health outcomes. "Our healthcare system today is not working to help the very people it's designed to serve," Jindal said at a press briefing. Jindal said change is needed because the state's Medicaid progran is on an unsustainable financial path. Whereas the program consumed about 8.5% of the general fund budget in 2006, it is projected to take up 21% by 2011.
The University of California-Davis Medical Center is one of a growing number of hospitals that dedicate a time block to creating a relaxing, peaceful environment for patients. Some medical centers, such as Montefiore Hospital in New York City, have a quiet floor around the clock. UC Davis modeled its "quiet time" on a similar program at Children's Memorial Hospital in Chicago.
An increasing number of family doctors are leaving the field for greener pastures and fewer young doctors replace them. South Florida has been hit hard by the trend, with dozens or even hundreds of primary-care doctors giving up their practices in recent years because of slow-growing income, increased business headaches, and unpredictable hours. To avoid a shortfall, the American Academy of Family Physicians estimates that Florida will need 63% more primary doctors within a decade, giving the state the third-highest gap in the nation.
HR can be a thankless task. You bust your hump adopting value-based benefit design programs that save your employees money and provide better care options with healthier outcomes, and what do you get in return? The thanks of a grateful workforce? Hardly! More like vacant stares and suspicions that you're poking into their private lives, trying to embarrass them, harm their careers, and save the company money at their expense.
Well, I hate to pile on, but if your employees don't understand that you're actually helping them save money and improve their lives, then it is your fault.
For the last two years, Midwest Business Group on Health, a nonprofit coalition of 96 large, self-insured employers, has surveyed employers in its coalition to measure their readiness to adopt value-based benefit design strategies that emphasize changing employees' unhealthy behaviors and to create a culture of health at the workplace. This summer, MBGH spoke with nine focus groups of more than 50 employees from three coalition companies to determine their understanding and reaction to value-based benefits. The results were disappointing.
Larry Boress, president and CEO of MBGH, says the central premise of value-based benefits—higher quality care at a lower cost—is simply "counterintuitive" to many employees. "The major disconnect is that, in general when people go into the marketplace to buy goods and services, they are accustomed to getting what you pay for: higher quality for more money," Boress says. "That idea is not necessarily true in healthcare. In fact, a high-quality physician might be more efficient and might in fact cost you less out of your pocket. A generic drug might be better for you because there is proven evidence for you."
The problem, Boress says, is that HR departments—generally speaking—aren't doing a good job communicating the goals of programs to employees. "It's all tied into communications and how it's presented," he says. "People often think 'if the employer wants me to do something, it is probably to reduce their costs.' What this tells us is that employers need to better educate employees about differences in quality healthcare and prepare employees to make quality choices and improve their health. Great care must be taken in communicating value-based benefits programs or employers will not only find a lack of participation, but also mistrust in their intentions to improve the health of their employees."
One size does not fit all
Different groups of employees provide different sets of challenges. "There wasn't one level of misunderstanding that everybody had," Boress says. "Managers tended to believe what the company said, but they didn't necessarily want to take a call from a disease management consultant telling them what to do. People who weren't in management were less-trustful of what the company was saying but more likely to listen to health information from an outside person."
Boress says employers who spent more time educating their employees about their benefits programs had the most success. He recommends beginning that education process anywhere from six to 18 months before the rollout. It also helps to use employees as peer advisors to explain and promote the benefits packages with their coworkers.
He said one particularly successful company uses volunteer employees who organize company-sponsored health and wellness programs and set up activities and intradepartmental friendly competitions like "The Biggest Loser" for weight loss. "We found that people don't want to be outliers. If they see that others in their organization, people they are working with, are all participating in something they are more likely to participate than even if the employers are paying an incentive," Boress says.
What you can do
What can your HR department do to promote value-based benefits?
"First of all, you have to take the time to understand your workforce, understand what their real lives are like, the pressures and limitations they face," Boress says.
Next, provide a lot of information ahead of time. "Explain why it's important to be healthy, how health can improve their quality of life, not just their productivity but their opportunity to see their grandchildren," Boress says. Reframe the discussion about quality so that employees know they can get better, more efficient care at lower cost.
Provide program choices. "Don't just offer one thing because employees don't want to be steered toward one thing," Boress says.
Reach out to spouses. "Spouses have a huge impact on whether or not somebody participates," Boress says.
Make sure your employees are health literate. "People often don't understand some of the terminology we use. What is value-based? What is an HpA1c score? You need to talk to them in ways they can understand. And we found that people don't want to be told there is a 'counselor' available. They'd rather be told there is a 'coach' available."
Stress that the process is strictly confidential. "People are always going to be mistrustful. When employees are asked to fill out health-risk appraisals they may feel that 'the employer is going to see what I've got and it's going to impact my future here.' They have to be told that is not the case. That is really key," Boress says.
The common thread here is communication. If you design a cost-effective benefits package for your employees, they won't benefit from it if they don't understand it. And they won't understand it if you don't explain it.
John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media HR, a free weekly e-newsletter that provides up-to-date information on effective HR strategies, recruitment and compensation, physician staffing, and ongoing organizational development.
